Provider Demographics
NPI:1578833869
Name:ANDERSON, HEATHER JEAN (RD)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:JEAN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 COMMUNITY DR
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3815
Mailing Address - Country:US
Mailing Address - Phone:516-562-3352
Mailing Address - Fax:516-562-2626
Practice Address - Street 1:400 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3815
Practice Address - Country:US
Practice Address - Phone:516-562-3352
Practice Address - Fax:516-562-2626
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006521133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered